Individual
DR. JEREMY LEE DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1139 E SONTERRA BLVD STE 205, SAN ANTONIO, TX 78258-4349
(210) 874-3359
Mailing address
PO BOX 847824, DALLAS, TX 75284-7824
(903) 877-7777
(903) 877-5080
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
BP10035367
TX
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
P4860
TX
Other
Enumeration date
06/02/2009
Last updated
11/27/2019
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